Formulaire

Request for Prior Approval - Medical Biology Examinations

Cerfa 10128*04 (S3132c)

Form to be completed for all acts of the nomenclature of medical biology acts subject to the obligation of prior agreement.

  • Strands 1 and 3: to be sent prior to the performance of the procedures to the medical service of the health insurance body to which the insured person depends
  • Part 2: to be retained by the insured

Access to the leaflet n°50053*04.

    Fill out the form

    To whom shall I send this form ?

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

    Je donne mon avis

    Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)

    Verified 04 November 2026 - Entreprendre Service Public / (Prime Minister)